Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study.

Alice N Hazemba,Busisiwe P Ncama,Sello L Sithole

doi:10.1186/s13006-016-0068-7

Abstract

BackgroundExclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa. We explored factors influencing the decision to exclusively breastfeed among HIV-positive mothers accessing interventions for prevention of mother-to-child transmission of HIV in selected sites of Zambia.MethodsThis exploratory qualitative study was embedded in research conducted on: HIV and infant feeding; choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia. Thirty HIV-positive mothers and six key informants were recruited from two health facilities providing mother-to-child HIV transmission prevention services. A semi-structured guide was used to conduct interviews, which were digitally recorded and simultaneously transcribed. Data coding and analysis was done with the support of QRS Nvivo 10 version software.ResultsDespite the known benefits of exclusive breastfeeding, gaps in understanding and potential for behaviour change remained. We found that information promoting exclusive breastfeeding may have been understood by mothers as instructions from the health care workers indicating how to feed their HIV-exposed babies rather than as an option for the mothers’ own informed-decision. This understanding influenced a mother’s perceptions of breast milk safety while on antiretroviral medicine, of the formula feeding option, and of the baby crying after breastfeeding. The meanings mothers attached to exclusive breastfeeding thus influenced their understanding of breast milk insufficiency, abrupt weaning and mixed feeding in the context of preventing mother-to-child transmission of HIV.ConclusionIn order to enhance feeding practices for HIV-exposed infants, our study suggests a broader health campaign supporting all mothers to exclusively breastfeed.

Highlights

Exclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa
The analysis identified four major themes that related to factors influencing the decision to exclusively breastfeed in the context of prevention of motherto-child transmission (PMTCT) as: (i) promotion of exclusive breastfeeding by health care workers (HCWs); (ii) the mothers’ understanding of information to exclusively breastfeed; (iii) the mothers’ reasons for choosing to exclusively breastfeed; and (iv) decision making on infant feeding and behaviour change in relation to PMTCT
All the HCWs in the selected sites were orientated to PMTCT interventions and trained in human immune virus (HIV) counselling and testing

Summary

Introduction

Exclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa. Mothers known to be infected with HIV risk transmitting the virus to their babies through breast milk, which has changed the landscape of infant feeding in sub-Saharan. Research has shown that breastfeeding – especially exclusive breastfeeding, limited to breast milk only, plus any minerals, vitamins and prescribed medicines that may be needed – for the first six months after birth reduces the risk of postpartum transmission of HIV from an infected mother to her baby [4,5,6,7]. HIVpositive mothers may have to go against cultural norms

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Results

Discussion

Conclusion